Abstracts of the 11th Annual SCMR Scientific Sessions - 2008
Meeting abstracts – A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/pdf/1532-429X-10-S1-info.pdf This abstract is available from: http://jcmr-online.com/content/10/S1/A302 © 2008 Mavrogeni et al; licensee BioMed Central Ltd Introduction Autoimmune diseases that are associated with active myocarditis include systemic lupus erythematosus, rheumatoid arthritis, Takayasu's arteritis, systemic sclerosis and autoimmune thyroid disease Patients may show myocarditis and/or pericarditis causing both short- and long-term morbidity and mortality Purpose To detect the presence of possible myocardial inflammation in patients with autoimmune diseases using CMR, immunohistological and PCR techniques Methods Seventeen patients, aged 20–55 yrs with various autoimmune diseases (2 with Takayasu's arteritis, with systemic lupus erythematosus, with rheumatoid arthritis, with autoimmune thyroid disease and with systemic sclerosis) presented with chest pain, shortness of breath or palpitations were included in the study All patients were in immunosuppressive treatment Two of them had slight increase of myocardial troponin I (2.5–3.5 ng/ml) After exclusion of coronary artery disease by coronary angiography, the presence of myocardial inflammation and the left ventricular systolic function were evaluated by Cardiovascular Magnetic Resonance (CMR) Myocardial inflammation was documented using T2-weighted (T2-w), T1weighted (T1-w) before and after contrast media injection and late enhanced images In 8/17 patients diagnosed by CMR as having myocardial inflammation, myocardial biopsy was also performed Biopsy specimens were evaluated by both immunohistological and polymerase reaction techniques (PCR) Results Myocardial inflammation was identified in 12/17 patients using CMR In the T2-w images the signal ratio of myocardium to skeletal muscle (latissimus dorsi) was 1.66 ± 0.58 (normal values 1.28 ± 0.05), indicative of myocardial oedema From the T1-w images the relative myocardial enhancement was 10.8 ± 12.4 (normal values 2.3 ± 0.69), indicative of myocardial inflammation Epicardial late gadolinium enhanced areas were also identified in 12/17 (in patients in the intraventricular septum (IVS), in in the inferolateral wall (INFL) and in in both IVS and INFL) The ejection fraction of left ventricle was decreased in 3/12 patients with CMR evidence of myocarditis (one with Takayasu's arteritis EDV = 210 ml, ESV = 160 ml, EF 24%, one with autoimmune thyroid disease EDV = 190 ml, ESV = 120 ml, EF 37% and one with rheumatoid arthritis EDV = 170 ml, ESV = 100 ml, EF 41%) The rest of them had normal ejection fraction At biopsy, immunohistology revealed inflammation in 4/8 (50%) PCR evaluation of myocardial specimens documented the presence of viral or microbial genomes in 7/8 (87.5%) Histologically proved myocardial inflammation and posPage of (page number not for citation purposes) Journal of Cardiovascular Magnetic Resonance 2008, 10(Suppl 1):A302 http://jcmr-online.com/content/10/S1/A302 itive myocardial PCR results were in agreement with 50% and 87.5% of positive CMR examinations respectively Herpes virus was identified in 3/8, Adeno in 1/8, Coxsackie B6 in 1/8, echo in 1/8, Parvo-B19 in 2/8, CMV in 1/ and Chlamydia trachomatis in 6/8) Coexistence of more than one viral genomes, was identified in 5/8 (62.5%) In one patient with rheumatoid arthritis only CMR was positive for myocardial inflammation Conclusion Myocardial inflammation with possible deterioration of LV function is a frequent finding in autoimmune diseases CMR can be used as a reliable, noninvasive tool to early diagnose myocardial inflammation in these patients and guide further treatment Publish with Bio Med Central and every scientist can read your work free of charge "BioMed Central will be the most significant development for disseminating the results of biomedical researc h in our lifetime." Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright BioMedcentral Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp Page of (page number not for citation purposes) ... (62.5%) In one patient with rheumatoid arthritis only CMR was positive for myocardial inflammation Conclusion Myocardial inflammation with possible deterioration of LV function is a frequent finding... identified in 3/8, Adeno in 1/8, Coxsackie B6 in 1/8, echo in 1/8, Parvo-B19 in 2/8, CMV in 1/ and Chlamydia trachomatis in 6/8) Coexistence of more than one viral genomes, was identified in 5/8... deterioration of LV function is a frequent finding in autoimmune diseases CMR can be used as a reliable, noninvasive tool to early diagnose myocardial inflammation in these patients and guide further treatment